Hyperkalemia
October 28, 2019

Approach to hyperkalemia :

Steps :

  1. True or psodo hyperkalemia
  2. ECG

Cause of Psodo hyperkalemia ?

  • Tourniquet to tight
  • Hemolysis
  • Leukocytosis
  • Thrombocytosis
  • Sample in Anticoagulant tube

If ECG normal Do ABG

ECG change :

  • Pecked T wave
  • Wide QRS
  • Loss p wave
  • Short QT
  • Prolonged PR

Treatment Options:

A/ Cardiac stabilization: Ca Gluconate / Chloride

  • Peripheral line: Ca gluconate ( Ampule 1g ,2g, Every 1 g in 10 ml NS infused over 3-5 min)
  • Central line: Ca chloride
  • Repeat ECG after 5 min if still changes >> give a second 1 gm calcium gluconate in 10 ml NSS
  • Repeat ECG After 5 minutes if still changes >> give a third 1 gm calcium gluconate in 10 ml NSS over 3-5 minutes
  • Repeat ECG and If still have changes arrange for URGENT DYALSIS

Notes:

  • Relative contraindication : if patient is on digioxin ( give 1 gm in 100 ml D5 over 30 min )
  • Renal patient if you will give bicarbonate and you will give ca glucnate :Do not give in same line to avoid tissue necrosis and particepate ca in vessel

B/ Intracellular shifting :

Temporary shift k about 4-6 h the k become high again

1-Insulin

  • If BS >250 just give insulin 10 u iv push
  • If BG < 250 give insulin and D 50

How much drop of k when you give insulin ?

  • the expected K drop is about 0.5 to 1 mEq in about 15-30 min so repeat the cycle if still high .
  • but it will come back in the serum in about 60 minutes if no chelating agent, so Repeat k in 30 m to f\u K level.

2-B2 agonist:

  • Synergetic effect to insulin u can’t give alone .
  • Albuterol:10-20 mg inhalation or 0.5 mg IV

Reduction of about 0.5 mEq per dose

3-NAHCO3:

  • Evidence to use it in hyperkalemia: If PH <7.2 only
  • Look for ionized ca and albumin to avoid tetany ( as alkalosis decrease ionized Ca)